Assessing the implementation of tuberculosis infection control practices in tuberculosis diagnostics and treatment health care facilities in Kampala district

Abstract

Back ground: Tuberculosis infection control in healthcare settings remains one of the world's biggest challenge in TB prevention and elimination, most especially in high TB burdened countries including Uganda. Health care workers at TB diagnostics and treatment health care facilities as well as patients might be at greatest risk of exposure to TB and hence need to be protected from the high risk of acquiring nosocomial TB infection. The major aim of this study was to assess the implementation of TB infection control measures in TB diagnostics and treatment health care facilities in Kampala district, a capital city of Uganda. Further, the study also explored the perceived barriers and enablers for the observed level of TB infection control practices in the 25 TB diagnostics and treatment health care facilities in Kampala district, from both health care workers and key informant's perspectives. Method: A cross-sectional study employing both qualitative and quantitative data collection approaches was conducted from July 31st to August 21st, 2015 in selected TB diagnostics and treatment health care facilities in Kampala district. The sample size for this study was obtained using the hyper geometric method yielding a total population of 49 health care facilities. A multistage sampling technique involving probability proportionate to size and simple random sampling without replacement was deployed in this study. Health care facilities were assessed using an observation checklist and a standardized TB infection control assessment checklist. Both key informant tool and focus group discussions were used for collecting qualitative data from key informants and health care workers respectively. Quantitative data from the health care facility survey was afterwards entered into Microsoft excel for analysis. Results:. A total of 25 TB diagnostics and treatment health care facilities participated in this study contributing to a response rate of 51%. Of the 25 health care facilities assessed, only 16% had a TBIC guideline and 36% had a TBIC plan. Reportedly, 36% regularly screened health care workers for TB, 52% reported that they had either acquired waterproof tents or recently installed fans in the consultation rooms or waiting area and 80% had previously done TBIC health care facility assessment since the beginning of the year. In 96% of the health care facilities assessed, at least one health care worker had received some level of training on TB infection control organized by Track-TB and/or NTLP. Only 12% had a designated area for sputum collection, 44% had fans installed either in the waiting areas and/or consultation rooms and 24% had bio-safety cabinets fitted with UV light in the laboratory. Although N95 masks were identified in 60% of the health care facilities assessed, health care workers were observed putting on N95 masks while talking to suspected TB clients at only 2 health care facilities. Averagely, 72.9% administrative/managerial, 64.5% environmental and 55.9% of the personal protective measures assessed were implemented at each or individual TB diagnostics and treatment health care facility respectively. However, no health care facility assessed adequately implemented all the three levels of TB infection control practices. Assigning a TBIC focal person to oversee the implementation of TBIC activities is critical. Commonly perceived barriers affecting TBIC implementation were; health care worker's negative attitude, stock outs of TB drugs and other laboratory supplies, lack of administrative support, loss of competent health care workers, TBIC knowledge deficiencies, Inadequate human resource, lack of motivation among HCWs, poorly designed infrastructure and lack of designated areas for sputum collection among others. Perceived enablers included; availability of community supporters, weekly supply of distilled water, acquisition of water proof tents, acquisition of phone boxes and monthly airtime, and availability of N95 masks. Job rotation and assigning responsibilities, administrative involvement, refresher trainings and continuous medical education, continuous supply of personal protective equipments were some of the suggested parameters that ought to motivate health care workers to continue practicing TB infection control practices. Conclusion: Some knowledge deficiencies and gaps still exists in the implementation of TB infection control practices in TB diagnostics and treatment health care facilities in Kampala district. This calls for greater efforts of the government and all implementing partners involved in the fight against TB in the country to fill out the gaps indentified in this particular study.